Anything more than 100 beats a minute qualifies as tachycardia, or elevated heart rate. Doug Miller, fire chief at a liquid natural gas terminal in Equatorial Guinea, was changing flights at Tambo International Airport in Johannesburg, South Africa, en route to Paris, when his heart rate pushed to almost double that.

"Moving my luggage across the terminal sent my heart rate out of sight," Miller said. "That continued for about four and a half hours."

An undetected thickening of the muscle in the upper right chamber of Miller's heart had begun to interrupt the electrical signals that operate the organ. Miller, who had worked as an EMT and paramedic early in his career, knew it was serious.

Unfortunately, the airport personnel treated the situation as routine.

"They took me to the airport dispensary, gave me an aspirin and checked my blood pressure," Miller said. "I was screaming at these people to get me to the hospital."

When an ambulance finally arrived, demands for money started to be made. The airport wanted $500 before he could leave. The paramedics wanted $500 for the two-mile journey to Johannesburg's leading cardiac hospital. At the hospital, the admissions staff asked for $5,500 before treatment could begin.

At that point, Miller's wife contacted International SOS Assistance, Inc., a worldwide provider of medical assistance, international healthcare, and security services. Through Marathon Oil, Miller is an International SOS member.

The situation dramatically improved, Miller said. First, the money fronted by the Millers from their bank account was immediately refunded. Next, International SOS medical personnel communicated directly with the hospital staff.

"They ran my case," Miller said. "Their doctors would call my heart doctor in Johannesburg to make sure the right tests were being done like an angiogram and exercise stress test. They talked to the nurses too."

Miller's wife was given a private room right in the hospital. In intensive care, Miller had a nurse at the foot of his bed at all times. Only when his doctor and International SOS agreed it was safe for him to travel, the Millers returned to the U.S. where Chief Miller had surgery to correct his heart condition.

"International SOS treated us like we were royalty," Miller said.

In 2007, more than half of the 850,959 cases handled by International SOS were medical, including evacuation and repatriation. With more than 7,700 corporate clients, the company serves 88 percent of the Fortune Global 100 and 64 percent of the Fortune Global 500.

"Our core business is medical assistance," Druckman said. "Say someone becomes sick while on a business trip. They call us, and we can direct them to a network of our providers that we can recommend."

International SOS operates at three levels that form the foundation of the worldwide medical and security services it provides around the globe. At level one, the company maintains 26 alarm centers worldwide which function around the clock. Each center has its own staff of doctors, nurses, coordinators and even aviation specialists when an immediate evacuation is required.

"The obligation of each alarm center is to have a network of the best available providers in its geographic territory," Druckman said. "For example, the Beijing alarm center is responsible for northern China. They know the best hospitals there and must be able to identify the best providers."

By establishing a financial relationship with those providers in advance, International SOS can guarantee expenses and get their patients treatment without delay.

Often the availability of medical care is not so much the issue as quality of care, he said.

"Just because you're staying in a five-star hotel does not mean the desired quality of care is available," Druckman said "Culturally, there are different medications and treatment regimens. They may put traditional treatment on a wound that would be very different from our treatment."

The level of training for health care providers is different as well, he said.

"Some medical providers are well trained and some are quite poorly trained from our perspective," Druckman said.

Interaction between doctor and patient may be structured differently. In China, as in many parts of the world, there is no such thing as primary care, Druckman said.

"If you have a cold, you go to the outpatient area of a hospital and wait to see a respirologist, an ENT (ear, nose, throat) for your runny nose or a neurologist for your headache," he said. "There are no doctors who see to the whole patient's needs."

Level 2 of International SOS operations involves 28 clinics owned and operated by the company, most of them in developing countries where a significant number of travelers and expatriates are found. For example, International SOS maintains clinics throughout China.

"We have clinics in Beijing, Shekou, Nanjing and Tianiin because the local medical services don't always meet international standards. Plus, cultural and language barriers often make it difficult to receive appropriate care," Druckman said. These clinics are available to the entire community, not just International SOS clients.

Level 3 of the International SOS game plan is providing medical care to remote site projects on behalf of a specific company or organization. At present, International SOS maintains more than 250 such projects.

"It could be anything from a first aid station operated by a nurse or providing paramedics in Iraq," Druckman said. "Or it could be a clinic for a company facility such as a mining site. So the scope varies with the size of the project and the medical need."

In some remote regions such as the Congo, the company clinic might be the only medical resource for thousands of miles. Because these companies function as part of the community, the medical resources available to the workforce are sometimes available to local residents.

At Miller's terminal on Bioko Island, International SOS maintains a clinic with two doctors available at all times. Also provided by International SOS were two paramedics.

"These were two of the best paramedics I have ever been around in my life," Miller said. "One was an Australian and the other was Swedish. International SOS just has top of the line people."

International SOS operates using a membership model, Druckman said. Companies can sign up as a corporate member covering all their international travelers and expatriates.?

"Organizations have the flexibility to design an operational procedure that is tailored to their needs," Druckman said.? "The organization pre-identifies managers who can provide immediate approval to proceed with an evacuation, for example, with the billing process already pre-arranged.? This significantly improves our ability to respond as financial issues don't get in the way of delivering the best possible care."

International SOS also offers an indemnified program for consumers who purchase membership where individual medical care is covered through a third-party medical? insurance provider.

"We provide the same service," Druckman said. "It's just a question of whether you are insured or not."

Among International SOS services are on-line tools to track and educate travelers.

"As soon as a traveler schedules a trip, we hook into their travel management systems and automatically e-mail them a note regarding where they intend to travel. For example, if the destination is Nigeria, we update them on the medical situation, what to do if issues arise and how best to protect themselves. Also, members can log onto our members-only website to receive up-to-date pre-travel medical and security information."

With a presence in more than 70 countries, International SOS often knows about a major crisis before the local government, allowing them to respond much faster. In October 2002, a bomb blast wrecked a nightclub in Bali, Indonesia, killing 202 people.

"We had a C130 on the ground three hours before the government even mobilized," Druckman said. "We had 11 burn victims flying out within 48 hours."

When a tsunami struck Asia in December 2005, multiple alarm centers were able to coordinate care.

"Our Singapore and Jakarta alarm centers were quickly overwhelmed with calls," Druckman said. "Because we had multiple alarm centers we could leverage our other centers to take over that overflow of calls. If one alarm center has a major issue and shuts down, we have another that can take over, giving our system redundancy."

In an age where most companies organize customer service around a single worldwide call center, usually outsourced to India, with competency sacrificed to the bottom line, International SOS takes great pride in operating on a regional basis.

?"We learned early on that a one-arm service doesn't work," Druckman said. "It makes things more complicated but experience taught us that you need to know if the local hospital is going to be under renovation next month or if Dr. Wong is going to be out on holiday. You're not going to know that from Baltimore."